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Alignment Health Clarity (HMO C-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Alignment Health Clarity (HMO C-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Alignment Health Clarity (HMO C-SNP) in 2026, please refer to our full plan details page.
Alignment Health Clarity (HMO C-SNP) is a HMO C-SNP plan offered by Alignment Healthcare USA, LLC available for enrollment in 2025 to people living in NorCal and SoCal. This plan received an overall rating of 4 out of 5 stars in 2026.
It's important to know that Alignment Health Clarity (HMO C-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
Alignment Health Clarity (HMO C-SNP)is a Special Needs Type (SNP) plan. This means you can only enroll in this plan if you meet specific criteria. See our full plan details page for more information.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Alignment Health Clarity (HMO C-SNP).
Plan Costs:
The cost of a Medicare Advantage Plan is made up of four main parts.
- First, the monthly premium — the amount you pay every month.
- Second, the deductible — the amount you pay out of pocket for covered services before the plan starts paying.
- Third, the copayments and coinsurance — the amounts you pay out of pocket for covered services, usually after meeting the deductible (if applicable). Copays are fixed dollar amounts; coinsurance is a percentage of the cost.
- Fourth, the Out-of-Pocket Maximum — the maximum amount you could have to pay out of pocket in a year. This may be different for in-network and out-of-network services.
For Alignment Health Clarity (HMO C-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $12.00. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $5.00. You must continue to pay paying your reduced Part B Premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has a $615.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $9250.00 for out-of-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $0.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
You can see below for the coinsurance and specific copayments for in the Additional Benefits section below, or refer to our Plan Details page for more details.
Common Services:
Doctor Visits:
Specialist Visits:
Emergency Room:
Urgent Care:
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Drug Coverage
The Alignment Health Clarity (HMO C-SNP) plan offers an Enhanced Alternative drug benefit with an annual prescription drug deductible of $615.00. After meeting this deductible, you will pay a 25% coinsurance for Tier 1, Tier 2, and Tier 4 drugs, and a 31% coinsurance for Tier 3 preferred brand drugs at standard pharmacies or through standard mail. There is no copay for Tier 5 specialty drugs during this initial coverage phase. Once your yearly out-of-pocket drug costs reach $2,100.00, you enter the catastrophic coverage phase and pay nothing for Medicare Part D covered drugs. Additionally, beneficiaries who qualify for the low-income subsidy will pay a reduced Part D premium of $12.00.
Additional Benefits
The Alignment Health Clarity (HMO C-SNP) plan offers comprehensive medical coverage where most outpatient, specialist, diagnostic, and dialysis services require no copay and a 20% coinsurance. Preventive care, including annual physicals and kidney disease education, is available with no copay and no coinsurance. For inpatient hospital stays and skilled nursing facility care, members are responsible for Medicare-defined copays and coinsurance. Value-added benefits include annual routine vision and hearing exams with no deductible, featuring a $500 eyewear allowance every two years and coverage for up to two prescription hearing aids per year. Additionally, members receive up to 50 one-way transportation trips to plan-approved locations with no copay or coinsurance, alongside a $124 monthly over-the-counter allowance. Medicare-covered dental services and medical equipment like prosthetics are also covered with a 20% coinsurance and no copay.
Inpatient Hospital See details
Inpatient Hospital benefits are partially covered by Alignment Health Clarity (HMO C-SNP), requiring prior authorization and a doctor referral for acute and psychiatric stays. Patients are responsible for Medicare-defined copays and coinsurance, while additional days, non-Medicare-covered stays, and upgrades are not covered.
Outpatient Services See details
Alignment Health Clarity (HMO C-SNP) covers outpatient services, including outpatient hospital, ambulatory surgical center, substance abuse, and blood services, with no copay and a 20% coinsurance. Prior authorization and doctor referrals are required for these covered benefits.
Partial Hospitalization See details
Partial hospitalization benefits are covered by Alignment Health Clarity (HMO C-SNP) with a 20% coinsurance and no copay. To receive these services, a doctor referral and prior authorization are required.
Ambulance and Transportation Services See details
Alignment Health Clarity (HMO C-SNP) covers ground and air ambulance services with a 20% coinsurance and no copay. Transportation services are partially covered, offering up to 50 one-way trips per year to plan-approved locations with no copay or coinsurance, while transportation to any health-related location is not covered.
Emergency Services See details
Alignment Health Clarity (HMO C-SNP) partially covers emergency services, as worldwide emergency transportation is not covered. Emergency services require a 20% coinsurance and no copay, urgently needed services have no copay and no coinsurance, and covered worldwide emergency and urgent care require a $75 copay and no coinsurance up to a $25,000 maximum.
Primary Care See details
Primary care benefits are partially covered by Alignment Health Clarity (HMO C-SNP), with podiatry services being excluded from coverage. Most covered specialty services, such as physical, occupational, and mental health therapies, require no copay and a 20% coinsurance, alongside prior authorization and doctor referrals.
Preventive Services See details
Alignment Health Clarity (HMO C-SNP) covers Medicare-covered preventive services, annual physicals, and kidney disease education with no copay and no coinsurance. Additional preventive benefits are partially covered; they include personal emergency response systems and caregiver support, but exclude health education, in-home safety assessments, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, chemotherapy wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, additional smoking cessation counseling, enhanced disease management, telemonitoring, remote access technologies, home and bathroom safety devices, and counseling services.
Hearing Services See details
Hearing services are partially covered by Alignment Health Clarity (HMO C-SNP) with no deductible, including one routine hearing exam and one fitting evaluation annually, as well as up to two prescription hearing aids per year. Over-the-counter (OTC) hearing aids and prescription hearing aids designed for the inner ear, outer ear, or over-the-ear are not covered.
Vision Services See details
Vision services are partially covered by Alignment Health Clarity (HMO C-SNP), featuring no deductibles, one routine eye exam every year, and a $500 combined maximum allowance every two years for eyeglasses or contact lenses. Eyewear upgrades are not covered under this plan.
Dental Services See details
Dental services are partially covered by Alignment Health Clarity (HMO C-SNP), with Medicare-covered dental services requiring a 20% coinsurance and no copay. While many preventive and comprehensive options are available, adjunctive general services, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Alignment Health Clarity (HMO C-SNP) covers Home Infusion bundled services, which require prior authorization. Covered Part B insulin drugs have a $35 copay and no coinsurance to 20% coinsurance, while chemotherapy, radiation, and other Part B drugs have no copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Alignment Health Clarity (HMO C-SNP) covers dialysis services with a 20% coinsurance and no copay. Prior authorization and a doctor referral are required to access these covered services.
Medical Equipment See details
Alignment Health Clarity (HMO C-SNP) partially covers medical equipment, as diabetic supplies are not covered under this plan. Covered services, including durable medical equipment, prosthetics, and therapeutic shoes, require prior authorization and carry a 20% coinsurance with no copay.
Diagnostic and Radiological Services See details
Alignment Health Clarity (HMO C-SNP) partially covers Diagnostic and Radiological Services, offering covered diagnostic procedures, lab services, and therapeutic radiological services with no copay and a 20% coinsurance. Diagnostic radiological services and outpatient X-ray services are not covered, and all covered services require a doctor referral and prior authorization.
Home Health Services See details
Home health services are covered under the Alignment Health Clarity (HMO C-SNP) plan, with prior authorization and a doctor referral required to receive these benefits.
Cardiac Rehabilitation Services See details
Alignment Health Clarity (HMO C-SNP) covers cardiac rehabilitation services with coinsurance and no copay, but some services are covered while cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services are not covered.
Skilled Nursing Facility (SNF) See details
Alignment Health Clarity (HMO C-SNP) partially covers Skilled Nursing Facility (SNF) benefits, requiring prior authorization and a doctor referral. Copays and coinsurance are based on Medicare-defined cost-sharing, and additional days beyond Medicare-covered SNF stays are not covered.
Other Services See details
Other Services are partially covered by Alignment Health Clarity (HMO C-SNP), with Dual Eligible SNPs with Highly Integrated Services being excluded from coverage. Covered benefits include up to 24 acupuncture treatments per year with prior authorization, a $124 monthly over-the-counter reimbursement allowance, digital health technology support, and meal benefits for eligible chronic conditions.
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